Stapes Surgery Outcomes in Otosclerosis Management

Otosclerosis is characterised by abnormal bone remodelling in the otic capsule that immobilises the stapes footplate and produces conductive hearing loss. Surgical intervention, most commonly stapedotomy or stapedectomy, restores ossicular continuity through placement of a prosthesis and achieves closure of the air–bone gap (ABG). Primary procedures yield ABG closure to within 10 dB in 70–90 per cent of patients, with preservation of bone conduction thresholds in over 90 per cent. Improvements in tinnitus and patient satisfaction correlate closely with audiological gains. Low rates of severe complications, including sensorineural hearing loss or vestibular disturbance, underscore the safety of modern techniques. Factors influencing outcomes include prosthesis material and design, surgical approach (microscope versus endoscope), perioperative protocols such as corticosteroid use, and surgeon experience. Revision stapes surgery, undertaken for persistent or recurrent conductive loss, achieves smaller ABG gains and requires tailored counselling. Emerging innovations in prosthesis geometry and intraoperative imaging promise further refinements in functional and patient-reported outcomes.

Research from Nature Portfolio

A foundational prospective study involving over a hundred patients undergoing stapedotomy demonstrated that postoperative high-frequency air conduction thresholds strongly predict improvement in pre-existing tinnitus. Younger individuals were more likely to experience tinnitus reduction, and those with tinnitus relief reported higher overall satisfaction. The analysis emphasised the value of preoperative counselling tailored by patient age and baseline acoustic profile. These findings have influenced subsequent guidelines on informing patients about expected auditory and tinnitus outcomes and have prompted more detailed preoperative audiometric assessment protocols to identify individuals at risk of persistent tinnitus.

Stapes Surgery Outcomes in Otosclerosis Management publication trend

The graph below shows the total number of articles in stapes surgery outcomes in otosclerosis management across all publications each year (not limited to Nature Index journals).

Technical terms

Otosclerosis: Primary disorder of the otic capsule causing abnormal bone turnover that fixes the stapes footplate and produces conductive hearing loss.

Stapedotomy: Microscopic or endoscopic creation of a small fenestra in the fixed stapes footplate followed by insertion of a prosthesis to restore ossicular chain mobility.

Stapedectomy: Surgical removal of the entire stapes footplate and replacement with a prosthetic device to bypass the immobilised stapes.

Air–bone gap (ABG): Difference in decibels between air conduction and bone conduction thresholds on pure-tone audiometry, reflecting the degree of conductive hearing impairment.

Revision stapes surgery: Secondary procedure performed after failure or suboptimal result of a primary stapedotomy or stapedectomy to correct persistent or recurrent conductive hearing loss.

References

1. High-frequency hearing, tinnitus and patient satisfaction with stapedotomy: A randomized prospective study. Scientific Reports (2015).
2. Audiological outcomes after revision stapes surgeries: a systematic review. European Archives of Oto-Rhino-Laryngology (2024).
3. Safety and efficacy of the mAXIS stapes prosthesis. European Archives of Oto-Rhino-Laryngology (2024).
4. Impact of surgeons’ experience and the single-shot perioperative antibiotic prophylaxis on outcome in stapedotomy. PLOS ONE (2021).